AVC

Impending genocide in the Democratic Republic of Congo. Cholera in Zimbabwe. HIV/AIDS. Collapse of the auto industry in the US. Global economic crisis! Are we having fun yet? If you are a VSO volunteer in Tanzania, the answer is yes! Because we just finished AVC! (Annual Volunteer Conference), a 3 day conference in Dar Es Salaam for all of the volunteers in Tanzania, Zanzibar and on the island of Pemba to discuss our issues. Those issues being - the work that we are doing, the strengths, challenges, the issues surrounding our respective sectors - "HIV/AIDS", "Secure Livelihoods", and "Education". We listened to individual and group presentations on "conflict management", "gender and HIV mainstreaming", received information from DFID (Department for International Development), watched an emotional and inspiring documentary on HIV/AIDS, and played the "Africa Game" during which time I found myself running around a pool with a bucket of water on my head. I came away soaked (but victorious)...
Getting back to the point, AVC was a very positive meeting. For me I came away with a better understanding of where VSO is, what volunteers are doing, and where we would like to be in 2009. The VSO Tanzania country director has said that despite the challenges (including the global credit crunch), that 2009 is promised to be a very good year for VSO - because next year a new CSP (Country Strategic Plan) will be developed. The CSP is important because VSO will hopefully make changes that will bring about better, more succesful placements to improve its development efforts.

I'm traveling back to Lindi tomorrow. 8 hours on the bus (6 hours on paved road and 2 hours on unpaved dirt :). I should be back in Lindi by 2pm, barring any flat tires and that we leave on time!

What's the message? I don't know. But despite the multitude of crises around the world, the seventy-plus VSO volunteers in Tanzania had a good and safe time in Dar at the AVC:) The picture was taken during lunch on day 2. The rest of the pictures will be uploaded onto Facebook.

Happy Holidays, and Happy New Year!

Hamna Umeme

"Hamna Umeme" translates to "There's no electricity". "Hamna Umeme" was the theme of today's clinic this morning. From 9am to Noon we had no electricity and I ended up telling almost all patients that unfortunately "hamna umeme" because when there's no electricity the hospital practically shuts down - the lab can not run any specimens and the radiology department can't use the back up generator, so patients can't get imaging. This means patients end up waiting extra long hours, usually the entire day to get treated. And usually the patients come back and tell me that there is no electricity. I tell them that unfortunately "hamna umeme" you just have to wait.....
The last two days were holidays due to Tanzania's independance day. I'm sure most people enjoyed having the last two days off, however, most people who enjoyed the last two days off ended up coming to the hospital sick today. The number of patients waiting in clinic was huge and at the reception desk, there was a continuous mob of people squeezing their way in to get a chart to see a doctor. I saw about twenty or thirty patients by noon and I ended up telling almost all of them that unfortunately we don't have electricity at the moment, so you just have to wait. Luckily the electricity returned around noon just as I was telling one of the last patients to wait.
All of my patients finished getting their labs drawn by about 3 pm and then the patients I had to scan all turned up at ultrasound.
The last patient I saw today was a young girl with five children. She was admitted to the hospital with a pregnancy of about 26 weeks and severe anemia. We scanned her today because of "size greater than dates" (in other words the size of the uterine fundus was greater than the number of weeks of pregnancy). The scan showed viable twins with concordant growth. I waited until after the scan and documentation to tell the woman she had two babies because I wanted to see the expression on her face when I told her the "good news":). I looked straight into her eyes and told her that she can expect two healthy babies :) I waited and waited, but she had absolutely no change in expression on her face! I asked her if she understood me, and she said she understood. But still no change in expression on her face! I was disappointed and confused that she looked emotionless. I just told her to return to the ward. I don't know how this woman will manage to support and raise seven children!

Future AMOs

Future AMOs (Assistant Medical Officers) of Tanzania. In about 6 months this class of 43 students will graduate and become Assistant Medical Officers. I have been teaching these students every Tuesday and Thursday for the last month on various ob/gyn topics. The majority of students seem to have a fairly good understanding of the material which I have taught so far, based upon the questions that they ask; however, I haven't given the students any examinations...yet, so I have no objective data to support my efforts. When the students are not in class they are rotating in various wards and clinics in the hospital in a curriculum which you might compare to that of 3rd year US medical students.
The picture above was taken at the end of my lecture today on cervical cancer....I'm always happy to see that everyone's eyes are open at the end of a lecture, especially since I lecture in the afternoons right after lunch!

Free Mangos

This was the scene at my house this afternoon. Looks like 8 little children are being held captive behind bars! Instead all of the kids are shouting for mangos at my front gate. Hadija, my housekeeper, is a little more generous than I am. I feel that if the children are given mangos that they will continue to return to my house and pester me for more mangos. Call me the grinch but I don't think its a good idea to be giving away mangos to little kids! Despite my pleading Hadija gave in and she gave the kids a few mangos! Surprisingly with only a few mangos, the kids left my house peacefully without protest or riots:)

No bones for you

Holiday presents arrived early this year for my 3 dogs, Obama, McCain and Bush. They are 3 lucky dogs!! The 3 of them received meat filled bones, chew toys, and a bunch of biscuits and treats courtesy of my parents, Allan and Darlene. Thank you!:)

The dogs were definitely surprised and very excited to receive their treats. As you can see, McCain is busy chewing away at a bone. Bush was also busy biting into her bone as was Obama. As soon as Obama received his bone, he took off running around my backyard in excitement. I went looking for him to take a picture but he's no where to be found. I think he's hiding in the bushes so no one can find him and steal his treat!

Another VVF

I saw four new VVF (Vesicovaginal fistula) patients in clinic today. Some VVF patients come from a dispensary or health facility with a referral letter requesting further management. Other patients simply come with the complaint of leaking urine. Sadly there are thousands of new VVF patients every year. For more information about VVF just 'google' VVF. Photo above is courtesy of bop.nppa.org.

The five patients I operated on on Friday were all doing okay this morning. And there were no seriously sick patients in the gyn ward. In Maternity we had a new case of ecclampsia and a mother who just arrived with severe anemia after delivering her baby at home.

I requested a consult from a medical doctor on one patient with presumed "tropical splenomegaly syndrome"... And I consulted medicine for another patient with a significant amount of ascites. The patient with ascites is a young girl who came with a distended abdomen and nausea vomiting. The etiology of the ascites has to be "worked up". I think we would be able to do a paracentesis although the lab would probably not be able to analyze the fluid.

On a separate note, I "fired" my plumber after two and a half months of aggrivating arguments about leaking faucets and water pumps not working. Fortunately my security guard knows another plumber who he recommends. And there is no real "urgency" to get the plumber here because now that the short rains have begun, I can use the rain water to cook, clean, shower, etc......everything except drink!

Tomorrow is a teaching day at the COTC (Clinical Officer's Training College). Our topic is cervical cancer. Definitely an important subject to teach Lindi's future doctors. There are definitely a lot of patients with cervical cancer and we are fortunate to have enough funding to help these patients get to Dar Es Salaam for treatment or if we catch the disease early enough to treat the patients with surgery.

A Full Moon

We had a full moon the other night. Maybe it was the moon's effect but a few strange things have been happening around here. At work its been unusually busy! Not a bad thing, just more work..... And one of the AMOs in the department is on 'likizo' (Vacation). The other AMO in the department is away at a teaching seminar. Thursday I spent most of the day doing ward rounds in Maternity. Almost a full day of rounding on patients because there are a ton of antepartum, post partum and gyn patients. After the ward rounds i went to clinic to see patients and then after clinic I went to ultrasound to scan a dozen or so patients.
Yesterday was a OR day. Did 4 hysterectomies (three vaginal hysterectomies and one abdominal hysterectomy) plus one cerclage placement. I took a short break for tea and bread around noon otherwise was busy in the OR operating all day. Was pretty tired after operations but still had more to do..... about a dozen or so patients were waiting in clinic and a few waiting for ultrasound. I was happy to be finished with all of the work by about half past 6.

The short rains are starting to come. Its nice because the weather cools off and we get a nice breeze from the ocean. The rains and the wind are causing a ton of my mangos to ripen and fall. This moring I went around picking up mangos in my back yard. I found thirty-two fresh mangos....... it felt like I was on an easter egg hunt. (Not that I have much experience in easter egg hunting:) but now I know what that's like). There are so many mangos that I end up giving most of them away. Otherwise if I eat them all I'd end up with some sort of mango toxicity!

In two weeks I'll be traveling to Dar Es Salaam for the annual VSO conference. Its a 3 day conference for all of the volunteers in Tanzania to come together to share stories about the work that's being done and to discuss issues during the past year and talk about future plans. Definitely looking forward to the conference.

Hope everyone is well at home and enjoyed Thanksgiving! Till next time......Badaaye (Later...)